The word rippling comes from the verb “to ripple” which means undulate or wave. In this case, the term is used to describe the appearance of wrinkles, folds or corrugations in the prosthesis after breast augmentation.
A few months or years after breast augmentation surgery some patients experience very unaesthetic wrinkles on their breasts called rippling. The appearance of rippling concerns patients as its unaesthetic result makes them feel instead of satisfied even less attractive with implants. This waviness or rippling is often felt when you touch it and can be also visible to the eye.
The rippling is one of the complications that can appear after augmentation surgery although its appearance doesn’t have to be immediate after the operation but it becomes visible after a few months or even years, at which time the patient believes she has already surpassed the period of possible complications.
The appearance of rippling is due to several factors. It is more common in very slim women whose prostheses are wider than what corresponds to the diameter of their chest and filled with a non-cohesive gel. The solution is to place cohesive gel prostheses with a wider base positioned at a subfascial or subpectoral level.
The folds usually look deeper on the outer side of the chest and cleavage due to the poor tissue coverage. They are also more visible when the woman bends forward.
This waviness or rippling is often felt when you touch it and can be also visible to the eye.
The medical literature says this complication is more frequent when saline filled implants are used but may also appear on silicone-filled implants. This waviness appears in the implant itself and becomes visible on the breast skin. Folds may appear not only in the old implants filled with little cohesive silicone but also in the most recent high cohesive silicone implants because the folds are formed in the shell of the implant.
Until recent years the use of smooth- surface implants had been recommended because the rough-surface implants can exert more traction on the skin and increase the rippling. However, the smooth prostheses have other disadvantages such as a higher rate of rupture.
Currently rough-surface implants with more cohesive filling and less risk of capsular contracture are used, which compensates the greater probability of creating ripples although the rippling may occur in both rough and smooth filling implants.
Surgeons warn that there is more risk of rippling in the following cases:
- Very slim women because they have less breast tissue coverage.
- In saline implants because the filling itself facilitates formation of waves or folds when pressed or moved.
- When the implant is placed behind the gland or beneath a fascia as there is less coverage of the implant.
- When too large prostheses are implanted.
- Finally, the percentage of filling of the prosthesis can also influence, because there are some which are not filled 100%. Some of them are filled up to 85%, especially the silicone gel, round and high profile implants, so that when the patient is standing, the prosthesis slightly empties from above and provides a more natural shape with no effect of looking too round.
Breast implant rippling can be avoided
As the appearance of these undulations or wrinkles is a medium or long term consequence, it can be avoided by taking into account the following aspects when choosing the prosthesis:
- The more layers the implants have, the lower the risk of wrinkling or folds of the skin.
- There is an endless number of brands, qualities, shapes, prices and above all, cohesiveness. Cohesiveness colloquially refers to the density of the silicone. A prosthesis is more secure, durable, uniform and stable greater its cohesiveness. High cohesiveness means that due to its high density and homogeneity it is not prone to the formation of rippling, therefore, as it does not wrinkle, it lasts longer. In a nutshell, these are all advantages.
- On the other hand, the low cohesiveness prosthesis can atrophy tissues. Soft or low cohesiveness breast implants thins the tissue down over time hence the appearance of undulations is not immediate. When it comes to low cohesiveness prostheses type I or II they create a centrifugal force around the tissues, leading to the progressive thinning of the same.
- When prostheses are superficial there is more risk. Ripples are usually more noticeable when the prosthesis is behind the gland because implants require a good cover tissue, so the ’deeper’ the better. In a thin patient with a certain level of atrophy in her tissues, with low cohesive implants, they have increased risk or tendency to fold and if placed behind the gland, the occurrence of rippling is very likely to happen.
- The price. High cohesive breast implants have a higher price as they’re better quality implants.
- Low cohesive breast implants are prone to folding and break before. The folds by friction pose a premature rupture of the prosthesis.
A new surgery, a safe solution against rippling
Once the rippling occurs, even though it depends on each case, it can be solved in part or completely with a new surgery. In most cases of rippling a further surgery is inevitable to carry out following three performances:
- Replacement to anatomical prosthesis.
- Placement in a deeper, therefore retropectoral plane.
- Fat grafting to help fill and thicken excessively thin glandular tissue.
In many cases anatomical implants are safer, more durable, more reliable and provide a more natural look of the breasts. They have a lot of advantages, but they also require a lot of experience and there is no room for possible mistakes made by plastic surgeon since they are more difficult to place.